AIM: This was a nationwide study by National Health Insurance Research Database to investigate the risk of urinary tract cancers (UTCs) for renin-angiotensin-aldosterone system inhibitors including spironolactone. METHODS: A total of 32 167 UTC patients with hypertension were enrolled in the National Health Insurance program between 2005 and 2011. RESULTS: Among different subclasses of renin-angiotensin-aldosterone system inhibitors, the adjusted odds ratio (OR) for UTC risk was 1...

OBJECTIVE: To determine the prevalence of primary aldosteronism (PA) in hypertensive patients presenting to the primary care clinic at The Mount Sinai Hospital, regardless of the degree of hypertension and to identify clinical criteria that should prompt screening for PA. METHODS: An aldosterone:renin ratio (ARR, cutoff ≥20, with plasma aldosterone concentration [PAC] ≥10 and suppressed renin) was used to prospectively screen 296 hypertensive patients (blood pressure [BP] ≥140/90) over the age of 18 from August 2012 through May 2013...

The aim of this paper is to evaluate the treatment effects of recommended drugs and devices on key clinical outcomes for patients with heart failure with reduced ejection fraction (HFREF). Randomized controlled trials (RCTs) listed in the 2012 HF guideline from the European Society of Cardiology as well as the 2013 HF guideline from the American College of Cardiology Foundation and American Heart Association were evaluated for use in the meta-analysis. RCTs written in English evaluating recommended drugs and devices for the treatment of patients with HFREF were included...

OBJECTIVE: The only reliable method for subtyping primary aldosteronism (PA) is adrenal venous sampling (AVS), which is costly and time consuming. Considering the limited availability of AVS, it would be helpful to obtain information on the diagnosis of bilateral hyperaldosteronism (BHA) from routine tests. We aimed to establish new, simple criteria for outpatients to diagnose BHA from PA before AVS. DESIGN: We retrospectively analysed 82 patients who were diagnosed with PA and underwent AVS...

BACKGROUND: Clinical care decisions to treat chronic kidney disease (CKD) in a growing child must often be made without the benefit of evidence from clinical trials. We used observational data from the Chronic Kidney Disease in Children cohort to estimate the effectiveness of renin-angiotensin II-aldosterone system blockade (RAAS) to delay renal replacement therapy (RRT) in children with CKD. METHODS: A total of 851 participants (median age: 11 years, median glomerular filtration rate [GFR]: 52 ml/min/1...

Primary aldosteronism (PA) is an important and commonly unrecognized cause of secondary hypertension. Idiopathic hyperaldosteronism and aldosterone-producing adenomas account for more than 95% of PA and are characterized, respectively, by bilateral or unilateral involvement of the adrenal glands. When there is suspicion for the presence of PA, a plasma aldosterone to renin ratio should be obtained initially. Localization to determine adrenal gland involvement is done by imaging, with computerized tomography or magnetic resonance imaging...

OBJECTIVE: Primary aldosteronism (PA) is a widely under-diagnosed, potentially curable and specifically treatable cause of hypertension. PA screening involves measuring the aldosterone-to-renin-ratio (ARR), but false negative results can occur in the setting of medications, which block the renin-angiotensin system (RAS). Withdrawing RAS blockers from patients with resistant hypertension is not without cardiovascular risk. A novel diagnostic approach, the aldosterone-to-angiotensin-II-ratio (AA2-Ratio), has the potential for less drug interference and improved reliability in PA screening and confirmation of diagnosis...

OBJECTIVE: Primary aldosteronism (PA) is form of hypertension characterized by production of aldosterone by the adrenal that is excessive and relatively autonomous of the renin-angiotensin system. Once detected, unilateral PA can be usually cured by surgical removal of the affected adrenal, while bilateral PA can be specifically treated by medications, which antagonize aldosterone action. Clinical guidelines of Endocrine Societies in Europe and the US recommend screening for PA among most hypertensive patients...

OBJECTIVE: Primary aldosteronism (PA) and sleep apnea syndrome (SAS) are common form of secondary hypertension. Some papers reported the group of high risk of SAS was higher rate of complication with PA than that of low risk of SAS. However, there are few reports which evaluated CPAP implementation rate of the PA patients with SAS diagnosing by Polysomnography (PSG). We aim to clarify clinical characteristics of patients of PA with SAS. DESIGN AND METHOD: We screened with Apnomonitor 284 PA patients who underwent adrenal venous sampling (AVS)...

OBJECTIVE: ACE inhibitors and angiotensin receptor blockers (ARB) modulate the renin-angiotensin system (RAS) leading to an increase in plasma renin activity (PRA) together with a reduction of plasma aldosterone concentration (PAC), likely proportional to the pharmacological effect. AIM: to evaluate the efficacy of therapy based on ACEI or ARB, using PRA/PAC ratio values in real-life clinical-practice. DESIGN AND METHOD: We studied 184 essential hypertensives (59...

Primary aldosteronism (PA) is severe form of hypertension characterized by a strongly increased aldosterone secretion mediated by adenomas or other forms of adrenal hyper-activity. Once detected, PA can be usually cured by either surgical intervention or by appropriate pharmacologic treatments. The incidence of PA among hypertensive patients varies strongly between different studies, which is in part caused by the complex state-of-the-art testing procedure that is unfortunately far away from being a versatile PA screening tool...

Primary aldosteronism (PA) involves more than 11% of patients referred to specialized hypertension centers and, therefore, is much more common than commonly held. Moreover, it causes a damage to the heart, blood vessels and kidneys, which translates into a high rate of cardiovascular events, in excess to the degree of blood pressure raise. Along with the notion that a timely diagnosis entails a fundamental step for the choice of an appropriate therapy, which can correct the arterial hypertension and the hypokalemia, this justifies efforts to search for PA in the majority of the patients with hypertension...

: Resistant hypertension refers to patients with difficult-to-treat hypertension, generally defined as needing three or more medications of different classes, including, if tolerated, a diuretic. Observational studies indicate that the prevalence of resistant hypertension based on the preceding definition of needing 3 or medications for blood pressure (BP) control is approximately 15-20% of patients being treated for hypertension. However, causes of pseudoresistance are common, including poor BP technique, poor adherence, white coat effects, and under-treatment, all of which must be identified in order to distinguish apparent resistance from true treatment resistance...

OBJECTIVE: To investigated the prevalence of primary aldosteronism (PA) and compare the pattern of PA patients with essential hypertension regarding clinical data in general hypertensive patients in Xinjiang of China. DESIGN AND METHOD: Consecutive hypertensive patients referred to Hypertension Center of Xinjiang from 2009 to 2011 underwent a diagnostic protocol composed of measurement of Na and K in serum and 24-h urine, sitting plasma renin activity, and aldosterone at baseline and after saline loading test...

OBJECTIVE: There are many reports about white coat hypertension (WCH), still the clinical significance and pathophysiology of WCH is ambiguous. The aim of this study was to find out the difference of RAAS activity in WCH compared with the essential hypertension (EH) group, which could suggest the role of RAAS activity in the development of WCH. DESIGN AND METHOD: Never treated hypertension patients who visited 8 hospitals of The Catholic University of Korea from January 2011 through July 2012 were enrolled...